Strategic Insights: Reviewing Performance and Refining Future Goals in the Global Fund

Author:

George Njenga Kiai

Article Type:

Article Number: 3

This article reviews the Global Fund’s Strategic Performance Report for 2017-2022 and the adjustments to the 2023-2028 Key Performance Indicators (KPI) Framework. What are the key achievements and areas for improvement in global health initiatives? Despite surpassing the life-saving target with over 34 million lives saved and achieving a 96% allocation utilization rate, challenges in reducing the incidence rates of HIV, TB, and malaria, along with integrating human rights-based approaches, remain. The adjustments to the KPI framework for the next period aim to refine measurement methods and address these challenges, ensuring future strategies are more effective and targeted.

Introduction

 

The Strategic Performance Report for 2017-2022 Key Performance Indicators (KPIs), reviewed at the end of 2023, and the adjustments to the 2023-2028 KPI Framework provide a comprehensive view of past achievements and future adjustments aimed at enhancing strategic goals. This article summarizes and analyzes the information presented in these documents, focusing on the results achieved during the 2017-2022 period and how the adjustments for 2023-2028 aim to address the identified challenges and opportunities.

 

2017-2022 Strategic Performance Overview

 

Lives Saved (KPI 1a): Over the 2017-2022 period, more than 34 million lives were saved, exceeding the target of 29 million. This achievement demonstrates the effectiveness of health programs in combating HIV, TB, and malaria. The overachievement suggests that while the decline in disease incidence rates was slower than anticipated, the health interventions in place were sufficiently robust to treat and manage the diseases effectively, thereby saving more lives than projected. For instance, in collaboration with President’s Emergency Plan for AIDS Relief (PEPFAR) and other partners, the WHO’s guidance of “treat all” and UNAIDS “95-95-95” strategy was implemented leading to a significantly increasing the number of people diagnosed with HIV and started on ART.

 

Incidence Reduction (KPI 1b): The combined incidence rate for HIV, TB, and malaria declined by 18.7% from 2015 to 2022, which did not meet the ambitious target range of 28%-47%. The documents attribute the slower pace of incidence reduction in part to the COVID-19 pandemic, which disrupted health services and diverted resources. Additionally, challenges such as drug resistance in malaria and TB further compounded the issue. The underperformance in this KPI underscores the need for strengthened efforts in disease prevention and control.

 

Allocation Utilization (KPI 7a): The utilization of allocated resources for GC6 grants was impressive, with a 96% utilization rate against a target of 91%. This indicates that the funds allocated for health programs were effectively disbursed and forecasted to be used efficiently, contributing to the overall success of the health initiatives.

 

Human Rights Barriers (KPI 9a): In addressing human rights barriers within health services, the efforts during the 2017-2022 period aimed at enhancing the integration of human rights-based approaches into health programming. Specifically, the initiative sought to ensure more inclusive health services by targeting discrimination, stigma, and access issues that disproportionately affect key populations, including those living with HIV/AIDS, TB, and malaria. While overall progress toward these comprehensive programming goals was uneven, advancements were made in certain contexts, illustrating the potential for significant impact where strategies were effectively implemented. For instance, Ukraine emerged as a notable example where concerted efforts led to marked improvements in HIV programming for key populations. This was achieved through targeted interventions aimed at reducing stigma and discrimination, enhancing legal support, and ensuring more equitable access to essential health services.

 

Despite setting ambitious objectives to dismantle legal, social, and economic barriers that impede access to health services for vulnerable populations, the Global Fund faced challenges in fully achieving these goals across the board. Under HIV, the ‘know your rights’ programs scaling-up and legal services becoming more accessible saw the most progress. However, attempts to improve laws, policies, regulations saw the least progress likely due to the action against human rights. Under TB, reducing discrimination against women saw the highest gains as did ‘know your rights’ programs scaling-up and legal services. Under malaria, two countries in the cohort had small-scale programs with limited geographic and population coverage.

 

Using the Breaking Down Barriers approach, national human rights plans when aligned with the scale-up of programmatic action, under the supervision of multiple stakeholders underscored their value in difficult contexts and served as the base to challenge the anti-rights movement.

 

The incremental progress observed, as exemplified by the strides made in Ukraine, underscores the importance of tailored, context-specific approaches to overcoming human rights barriers in health. It reflects a critical understanding that while overarching goals may unify global health initiatives, the pathways to achieving these outcomes are necessarily diversified, reflecting the complex socio-political landscapes in which these health programs operate.

 

2023-2028 KPI Framework Adjustments

 

The Global Fund’s approach to developing the Monitoring & Evaluation (M&E) Framework addresses complex performance measurement challenges. Stakeholders have welcomed the new Independent Evaluation Panel (IEP) and anticipate the Chief Evaluation and Learning Officer’s (CELO) contribution to leveraging the M&E Framework for improved learning and accountability. The effort to embed KPIs within a coherent M&E framework and the emphasis on evidence-based decision-making have been particularly appreciated. Stakeholders have noted the promise of new KPI sets focused on community engagement, pandemic preparedness, and integrated systems, highlighting the introduction of a Gender Marker throughout the framework as a significant step forward​. Read more on our analysis measuring the performance of the new Global Fund Strategy.

 

Adjustments to the KPI framework for 2023-2028 reflect a strategic response to the lessons learned during the previous strategy period. These adjustments are non-material, meaning they do not fundamentally alter the performance targets or expectations but rather refine the measurement and tracking methods to enhance clarity, relevance, and responsiveness.

 

• Data-Driven Adjustments: Changes to data sources and baseline definitions for several KPIs aim to improve the accuracy and reliability of performance tracking. For example, the shift to using more direct and evidence-supported data collection methods for KPIs related to data-driven decision-making (S6b) and disaggregated data use (S7) enhances the ability to measure progress more effectively.
• Refinement of Cohort Definitions: For KPIs such as on-shelf availability (S8) and mitigation actions for co-financing commitments (R1b), the adjustments refine the cohort definitions, ensuring a more targeted and relevant evaluation of outcomes.
• Inclusion of Baselines: Establishing clear baselines for newly introduced or adjusted KPIs, such as those related to laboratory testing modalities (P1) and early warning surveillance functions (P2), sets a benchmark for future assessments of progress and impact.

 

Integration into Strategic Recommendations

 

The strategic performance report underlines the Global Fund’s effective mobilization of resources, exceeding the Fifth Replenishment target with a pledge fulfillment forecast of 101%. This achievement is complemented by significant strides in market shaping, such as the expected surpassing of annual savings targets through direct procurement mechanisms, particularly in antiretroviral (ARV) drugs procurement, and the successful roll-out of new MDR-TB regimens in 20 countries​​.

 

However, the report also underscores persistent challenges in service delivery, particularly for key populations, and in coverage areas such as prevention of mother-to-child transmission (PMTCT) and antiretroviral therapy (ART) coverage, which are crucial for the HIV response. The absorptive capacity of grants has improved, offering better disaggregated results by age group and gender, yet gaps remain that necessitate focused attention​​.

 

To address these challenges, the strategic recommendations should incorporate a dual focus: leveraging the successful resource mobilization and market shaping achievements to enhance service delivery and extending coverage to key populations. Additionally, the Global Fund’s development of a new performance reporting framework that merges key performance indicators (KPIs) with Strategy Implementation Reporting (SIP) offers a more holistic overview of performance, setting a precedent for future strategic planning and implementation​​.

 

Analysis and Implications

The achievements in saving lives and improving program efficiency stand out as testament to the strategy’s impact. However, the challenges in incidence reduction and addressing human rights barriers underscore the need for continued innovation and adaptation in strategy implementation. The adjustments for the 2023-2028 period, while non-material, are critical for aligning the KPI framework with the evolving health landscape and the lessons learned from previous years. These refinements aim to enhance the strategic focus on data quality, measurement accuracy, and the relevance of performance indicators, thereby supporting more effective decision-making and program implementation.

 

Overall, the combination of past achievements and forward-looking adjustments highlights the dynamic nature of strategic planning in global health. It emphasizes the importance of continuous learning, adaptation, and commitment to improving health outcomes through strategic, data-driven, and rights-based approaches. Feedback from stakeholders has been crucial in shaping the strategic direction, underscoring the importance of partnerships, enhanced performance measurement, and the effective use of country-level data as discussed in Aidspan articles on the Global Fund’s M&E Framework, the need for partnerships, indicators that are off-track, and the latest strategic performance insights.

 

The carefully considered adjustments to the KPI framework signify a commitment to not only continue the fight against HIV, TB, and malaria but to do so with an increasingly refined, data-driven approach. This evolution in strategy, informed by lessons learned and aimed at addressing the nuanced realities of health interventions, positions future initiatives to combat these diseases more effectively and improve health outcomes worldwide. As we move forward, it will be crucial to maintain this adaptive and responsive approach, ensuring that strategic goals are aligned with the evolving landscape of global health and the diverse needs of communities around the world.